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SCIENTIFIC PRINCIPLES OF

TOOTH
PREPARATION
Contents
•Introduction
•Objectives of tooth preparation
•Principles of tooth preparation
•Biologic :
•Mechanical :
•Esthetics :
•Summary
•References
Introduction
What is tooth preparation?
The process of removal of diseased and/or healthy enamel and
dentinMechanical
and cementum to shape
treatment a toothdisease
of dental to receive a restoration
or injury to hard
tissues that restore a tooth to original form
OBJECTIVES OF TOOTH
PREPARATION…….
TYLMAN
Reduction of a tooth in miniature to provide

retainer support.

Preservation of healthy tooth to secure resistance

form.

Provision for acceptable finish lines.

Performing pragmatic axial tooth reduction to

encourage favourable tissue responses from artificial

crown contours.
The principles given by ……..SHILLINBERG

1. Preservation of tooth structures

2. Retention and resistance form

3. Structural durability

4. Marginal integrity

5. Preservation of the periodontium


Biologic Considerations
 Prevention of damage during tooth
preparation

1.Adjacent Teeth
-damaged tooth even if reshaped and recontoured is
always more susceptible to caries

• Less fluoride content


• More plaque retention
AVOIDED BY:
Placing a matrix band interproximally
leaving thin lip/ fin of enamel intact
Interproximally.

2.Soft Tissues :Aspirator tip , mouth


mirror.
• Pulp :
Great care-to prevent pulpal injuries

Pulpal degeneration occurs after many


years of tooth prep

Extreme temp
Chemical irritation—Irreversible pulpitis
Microorganism
• Temperature change in pulp during complete crown
preparation
P.D.Laforgia
J Prosthet dent 1991;65:56

Using air-water spray- decrease in temp of pulp chamber

• Using only air spray- increase in temp

• Avoided by:

• A light touch should be used for preparations. Use of water spray


•Chemical Action
-Bases, Restorative Resins, Solvants, and Luting Agents.

AVOIDED BY: Cavity Varnish / Dentin Bonding Agents

•Bacterial Action
-Due to bacteria left behind after preparation or having
gained access to dentin due to microleakage.

AVOIDED BY: Removal of all carious dentin before tooth


preparation.
Conservation Of Tooth Structure

Minimum convergence angle.

Partial coverage. Anatomic reduction

Apical extension. Axial surface reduction.

Conservative margin
Considérations Affecting Future
Dental Health
• CAUSE • EFFECT

Insufficient Tooth Overcontoured Restoration


Reduction
Occlusal Dysfunction
Inadequate Occlusal
Reduction
Chipping of Enamel/ Cusp
Poor Margin Location fracture
Axial Reduction   

-Sufficient space for Good axial contours.

-Must Duplicate the contours and profile


of the original tooth.
Margin Placement:

-A Supra-gingival Margin should be preferred over a Sub-gingival


Margin.

Advantages of a Supra-gingival Margin are:


Easily finished
 Easily cleansible
 Ease of impressions
 Easy Evaluation
Indications of Subgingival preparation
Dental caries , cervical erosion
 Contact areas extended to gingival crest
 Retention
 Margin has to be hidden
 Root sensitivity

C B
Margin Adaptation –
Recurrent caries – dissolution of cement
Accurate adaptation
Irregular or stepped junctions

D B
• Bader et al., in 1991, studied the effect of crown
margins on periodontal conditions of patients
receiving regular care.

• They concluded that even in such patients


subgingival margins are associated with
unfavourable periodontal conditions.
 
• William G. Reeves in 1981 restorative margin placement
and periodontal health.

• The degree of gingival inflammation was influenced by;


– Failure to maintain proper emergence profile
– Inability to properly finish subgingival
margins.
– Placement of gingival margins with little or no
attached gingiva.
– Violation of biologic width.
Margin geometry
•Preparation without overextension & unsupported
enamel
•Ease of identification

•Distinct boundary

•Bulk of material

•Conservation of tooth
ROSENSTEIL

Title
To Bevel… Or, Not to Bevel…

d=D sinµ D=d/sinµ


SHILLINBERG
• Gravelis et al., in 1981, evaluated the effect of
various finish lines preparation on the marginal seal
of full crown preparation.

• The feather edge and parallel bevels show the best


marginal seal followed in order by full shoulder, 450
shoulder and finally by 900 shoulder with 300 and 600
bevels.
• With regard to seating of restoration, the 900 full
shoulder showed the best seat followed by 450
shoulder, 900 shoulder with 450 bevel, feather edge,
900 shoulder with 300 bevel and finally 900 shoulder
with parallel bevel.
 
According to Charles Goodacre,JPD 2001
• When tooth conditions and esthetics permit, finish lines
should be located supragingivally.
• When subgingival finish lines are required, they should not
be extended to the epithelial attachment.
• Chamfer finish lines approximately 0.3 mm deep are well
suited for all-metal crowns.
• Both shoulder and chamfer finish lines can be used with all-
ceramic crowns if the crowns are bonded to the prepared
teeth.
Preventing Tooth Fracture –
Minimize destructive stresses-decreases fracture
inlay - wedge opposing walls
Providing a cuspal coverage restoration -
complete crown.
Mechanical Considerations
Retention Form

Resistance Form

Structural Durability
1. Retention Form:-
The quality of the restoration that prevents the restoration from
being dislodged by force parallel to the path of placement
called as retention form.
Retention Form :

•Magnitude of the dislodging forces

•Geometry of the tooth preparation

•Roughness of the fitting surface of the restoration

•Materials being cemented

•Film thickness of the luting agent


Magnitude of the dislodging forces
Depends on the stickiness of food

Geometry of the tooth preparation –


prosthesis depend on the geometric form rather than -
cements
Cement is effective only if the restoration
has a single path of placement
1Closed lower pair of kinematic elements
- Formed by two cylindrical surfaces
- curve of a complete crown - closed
grooves - partial crown - prevent movement at right
angles
- complete crown - over tapered - no longer be cylindrical,
2Taper -
Theoretically, maximum retention - parallel walls –
undercuts
Taper small – limited path of withdrawal
Ward - first to recommend taper of 3 to 12 °
Jorgensen and Kaufman - 2.5.to 6.5 ° - optimum
Ohm and Silness –

mean taper of 19.2° mesiodistally &


23.0° faciolingually on vital teeth.

12.8° mesiodistally
22.5° faciolingually on non-vital teeth.

Weed et al found ….12.7° on typodonts, but clinical


preparations had a mean taper of 22.8°
Noonan and Goldfogel : overall mean taper on
student prepared full gold crown preparations- 19.2º

Mack : A minimum of 12º taper is essential to insure


the absence of undercuts.

Dodge , Weed, and Buchanan : A taper or total


convergence of 16° ... achievable clinically - adequate
retention
3Freedom of Displacement.
Maximum retention - when there is only one path
….long parallel axial walls
Definite wall perpendicular to the direction of the force
….
Proximal box - Buccal and lingual wall…meet the pulpal
wall …near 90°
4Surface Area:-
•Crowns with long axial walls are more retentive than crowns
with short axial walls.
•Molar crowns are more retentive than premolar crowns of
similar taper.
John Bowley,2007
There is a significant difference in both 3 and 4mm
vertical heights compared to 2 degree ideal preparation.
Both grooves and boxes provided significant improvement
of total surface area for both 3-4mm preparation
5Stress Concentration:-
Cohesive failure occurs within the cement as the
stress within cement is less than that of induced stresses.
Stresses are seen to concentrate around the junction of axial
and occlusal surfaces.
Modifications like rounding of internal line angles will
reduce the stress concentration and increase retention of
the restoration.
6Types of Preparation:
It is seen that retention of complete crowns is almost
twice as that of partial coverage. Grooves or boxes in a
preparation which limit the path of withdrawal enhances the
retention

J Prosthet Dent
1980:43;303
7Path of insertion
Imaginary line along which the restoration will be
placed.
Survey a preparation …..12 inches
….preparation to be surveyed in the mouth - ½ inch
above the preparation
For metal ceramic crowns, the path - parallel - long
axis of the teeth.

Partial Coverage Restorations


According to Charles Goodacre, JPD 2001
1.The total occlusal convergence, ideally should range between
10- 20 degrees.

2. 3 mm should be the minimal occlusocervical /incisocervical


dimension of incisors and premolars prepared within 10 to 20
degrees of TOC.

3. The minimal occlusocervical dimension of molars should be 4


mm with 10 to 20 degrees TOC

4. The ratio of the occlusocervical/incisocervical dimension of a


prepared tooth to the faciolingual dimension should be at least
0.4 or higher for all teeth.
•Roughness of the Surfaces Being Cemented
If Internal surface of a restoration is very smooth-
retentive failure occurs at the cement restoration
interface
Restoration is roughened or grooved.
Air-abrasion - with 50 µm of alumina – 64%
retention
• Anthony H.Tjan,1986 ,found no difference was found in
retention between crowns in which the preparations were
polished and cleansed with polyacrylic acid and casting
microblasted

those in which tooth preparation were neither polished nor


treated with polyacrylic acid and casting not microblasted and
cemented with glass ionomer cement
• Mohammad F Ayad,1997 found optimal retention of artificial
crowns with zinc phosphate cement was recorded with tooth
preparations completed with carbide burs.

• Cross cut carbide burs improved retention of complete cast


crown cemented with zinc phosphate cement by 46% to 55%
compared with tooth preparation completed with diamond
stones or finishing burs
d. Materials being cemented:-
• Retention is affected by both casting metal and core
build up material.

• So, base metal alloys are more reactive than the less
reactive high gold content metals.

e.Type Of Luting Agent

Adhesive resin cements are the most adhesive


The retention of complete crowns prepared with
three different tapers and luted with four different
cements

Omar Zidan and Gary C. Ferguson

J P D 2003;89:565-71
1. The mean retentive strength of crowns cemented with zinc
phosphate (3.7 Mpa) or conventional glass ionomer (3.6
Mpa) was
significantly lower than the mean retentive strength of
crowns
cemented with resin cements (6.5 Mpa).

2. Increasing the taper to 24 degrees decreased the


retention of crowns significantly. Crowns luted with
resin luting agents demonstrated significantly greater
bond strengths for preparations with taper greater than
12 degrees.
Resistance form:
Depends on
Magnitude and direction of the dislodging
forces
 Geometry of the tooth preparation
 Physical properties of the luting agent
Magnitude and Direction of the Dislodging Forces.
Properly designed occlusion, the load should be well
distributed …

Geometry of the Tooth Preparation

Concept of resistance area(RA)


Length Width
Hegdahl and Silness - Increased
preparation taper and rounding of
axial angles tend to reduce
resistance
Molar teeth require more
parallel preparation
Partial-coverage
Resistance must be provided
by grooves , boxes or pinholes
• Method to analyze resistance form

DCNA ,April 2004


Physical Properties Of Luting Agents

Compressive strength of re-inforced ZnOE is halved at mouth


temperature.

Zinc Phosphate has high modulus of elasticity so retention


depends less on taper when compared to Zn Polycarboxylate

Adhesive resin>Resin>Glass Ionomer>Zinc


Phosphate>Polycarboxylate
Structural durability

A restoration must contain a bulk of material that is adequate


to with stand the forces of occlusion. This bulk must be confined
to the space created by the tooth preparation.
Occlusal reduction.
Functional cusp bevel.
Axial reduction.
One of the most important feature for providing adequate bulk
of metal and strength to the restoration is occlusal clearance.
Functional cusp Non functional cusp

All metal 1.5 1.0

Metal ceramic 1.5-2.0 1.0-1.5

All ceramic 2.0 2.0


AXIAL REDUCTION

Plays an important role in securing space for


an adequate thickness of the restorative
material.
Esthetic Considerations

Metal-ceramic restorations :
Facial tooth reduction :
Adequate reduction of the facial surface – Color
depth and translucency.
Minimum reduction of 1.5 mm
Incisal Reduction
incisal edge – no metal backing
- translucency – 2mm
reduction.

Proximal Reduction
extent is contingent on the
location of metal-ceramic
junction.
Proximal surface with no metal
Supragingival margin - Easier to keep clean
Subgingival margins - Indicated for esthetic reasons - when
the patient has a high lip line
Partial-coverage restorations :

Proximal margin : …place the margin just buccal to


proximal contact area - metal - hidden by the distal line
angle.

Tooth preparation angulation


Facial margin :

• Just beyond the occlusofacial line


angle.
• A short bevel is needed to
prevent enamel chipping
• If buccal margin - correctly
shaped, no reflection of light
• Mandibular partial cast crowns -
metal display is unavoidable
• A chamfer, rather than a bevel, is
recommended for the buccal
margin
• According to Charles Goodacre
• Axial and occlusal reductions for all-metal crowns should be
at least 0.5 mm deep and 1.0 mm deep, respectively.
• For metal-ceramic crowns, Facial /axial reductions in excess of
1 mm can compromise the remaining tooth structure external
to the pulp, whereas 2.0 mm of occlusal reduction is
commonly achievable even on a young tooth.
• With all-ceramic crowns, it is not necessary to exceed 1 mm
of axial reduction with semitranslucent systems and higher
value, lower chroma shades.
• 2 mm incisal/occlusal reduction for all ceramic crowns
CONCLUSION

Successful restoration:

Accurate diagnosis

Thoughtful Rx planning

Preparation design
References:
1. Johnston’s modern practice in fixed Prosthodontics .
2. Contemporary fixed Prosthodontics : Rosenstiel, Land
Fujimolo.
3. Fundamentals of fixed Prosthodontics : Shillingburg
4. Fundamentals of fixed prosthodontics : Tylman
5.Lee M.Jameson, Crown contours and gingival response
Prosthet Dent 1982;47:620
6.William G Reeves, Restorative margin placement and
periodontal health Prosthet Dent 1991;66:733
7.J.R.Gravelis,The effect of various finish line preparations on the
marginal seal and occlusal seat of full crown preparations
8.Donald A.Behrend,Ceramometal restorations with
supragingival margins Prosthet Dent 1982;48:4
9 . P.D. Temperature change in the pulp chamber during complete crown
preparation, J Prosthet Dent 1991;65:56
10.Charles J. Goodacre, Tooth preparations for complete crowns: An art form
based on scientific, J Prosthet Dent 2001;85:363-76.
11.Merle H. Parker, Evaluation of resistance form for prepared teeth Prosthet
Dent 1991;66:730
12.Periklis Proussafs,The effectiveness of auxillary features on a tooth
preparation with inadequate resistance form J Prosthet Dent 2004;91:33
13.John F. Bowley,Surface area improvement with grooves and boxes in
mandibular molar crown preparation Prosthet Dent 2007;98:436
14.Anthony H Tjan,Effect of preparation finish on retention and fit of
complete crowns,J Prosthet Dent,1986;56:283
15.Mohammed F.Ayad,Influence of tooth surface roughness and type of
cement on retention of complete cast crowns,J Prosthet
Dent,1997;77:116
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